- most important complication of ANDV infection is hantavirus cardiopulmonary syndrome (HCPS), which is associated with a high mortality rate
- milder illness without significant cardio-respiratory compromise may also be seen. Illness usually develops 2 to 4 weeks following exposure, but incubation periods as early as 4 days and up to 8 weeks have been described
Clinical features of ANDV infection:
- include an initial prodrome, which may be an influenza-like or non-specific febrile illness, with fever, chills and myalgia, and sometimes gastrointestinal symptoms
- vomiting, diarrhoea and abdominal pain may be the only initial symptoms in some cases
- conjunctivitis and petechiae may also be present
- upper respiratory tract signs and symptoms tend to be absent
- in progressive illness:
- the prodromal symptoms worsen and then acute respiratory compromise and hypotension follow quickly, usually heralded by onset of a dry cough.
- represents the cardiopulmonary phase, with capillary leakage in the lungs
- abdominal pain may be present and can be severe
Complications include:
- respiratory failure
- acute respiratory distress syndrome
- acute pulmonary oedema
- shock,
- coagulopathy and haemorrhage
- cardiac arrhythmias
- neurological complications are uncommon but encephalopathy, encephalitis, meningitis and seizures may occur
- mortality rate is typically 35 to 50%
Laboratory Features:
- thrombocytopaenia
- is common
- may be seen in the prodromal phase
- increases in blood lactate dehydrogenase may be seen initially, followed by increases in blood lactate and liver transaminase levels
- may be evidence of acute renal impairment
- neutrophilic leukocytosis and the presence of immunoblasts in peripheral blood may be seen, particularly in more severe disease
The resolution of the cardiopulmonary phase can also be rapid (over 24 to 48 hours in some cases), but complete recovery from HCPS can be a protracted process.
Reference:
- Public Health England (May 2021). Andes hantavirus: epidemiology, outbreaks and guidance